DD Form 2648-1, Preseparation Counseling Checklist for ...

[Pages:3]PRESEPARATION COUNSELING CHECKLIST FOR RESERVE COMPONENT SERVICE MEMBERS RELEASED FROM ACTIVE DUTY

(Please read Privacy Act Statement below before completing this form.)

SECTION I - PRIVACY ACT STATEMENT

AUTHORITY: 10 USC 1142, E.O. 9397. PRINCIPAL PURPOSE(S): To record preseparation services and benefits requested by and provided to Service members; to identify preseparation counseling areas of interest as a basis for development of an Individual Transition Plan (ITP). The signed preseparation counseling checklist will be maintained in the Service member's official personnel file. Title 10, USC 1142, requires that not later than 90 days before the date of separation, preseparation counseling for Service members be made available. ROUTINE USE(S): None. DISCLOSURE: Voluntary; however, it will not be possible to initiate preseparation services or develop an Individual Transition Plan (ITP) for a Service member if the information is not provided.

SECTION II - PERSONAL INFORMATION (To be filled out by all applicants)

1. NAME (Last, First, Middle Initial)

2. SSN

3. GRADE

4. SERVICE (X one)

5. PLACE OF RELEASE FROM ACTIVE DUTY

Army National Guard Air National Guard Army Reserve

Marine Corps Reserve Air Force Reserve Coast Guard Reserve

6. ANTICIPATED DATE OF RELEASE FROM ACTIVE DUTY (YYYYMMDD)

7. DATE CHECKLIST PREPARED (YYYYMMDD)

Naval Reserve

SECTION III. ALL TRANSITIONING SERVICE MEMBERS MUST READ INSTRUCTIONS, SIGN AND DATE.

a. Items checked "YES" are mandatory for Service member to receive further information or counseling, or attend additional workshops,

briefings, classes, etc. Service members that check "YES" in Item 11.a. will be released by Commanders to attend the appropriate

workshop, briefing, etc. in its entirety, if Service member has sufficient time remaining on active duty and attendance can be accomplished

prior to completion of demobilization out-processing.

b. Shaded Areas: Areas that are shaded mean (1) the information is not applicable or (2) the information is referring to a Web site address

and the URL requires no explanation. For example: 11.b. is shaded under SPOUSE because DD Form 2586 does not apply to spouses.

Items 11.f.(1) and (2) are shaded because they refer to Web site addresses and they require no explanation.

c. I was offered preseparation counseling on the above date (Item 7) on my transition benefits and services as appropriate. I understand that

this preseparation counseling is provided to assist my transition process as required by Title 10, USC, Chapter 58, Section 1142.

d. I have checked those items where I desire further information or counseling. I have also been advised where to obtain assistance in

developing an Individual Transition Plan (ITP).

e. I

accept

decline (X appropriate block) preseparation counseling. (If you check the "decline" box, you are declining

preseparation counseling only on those items on this checklist where you have the option of declining.) Sign and date the checklist.

8a. SERVICE MEMBER SIGNATURE

b. DATE (YYYYMMDD) 9a. TRANSITION COUNSELOR SIGNATURE b. DATE (YYYYMMDD)

SECTION IV. Please indicate (by checking YES or NO) whether you (or your spouse if applicable) desire counseling for the following services and benefits. All benefits and services checked YES should be used in developing your ITP. The following services and benefits are available to all Service members, unless otherwise specified:

10. EFFECTS OF A CAREER CHANGE

11. EMPLOYMENT ASSISTANCE

a. Dept. of Labor sponsored Transition Assistance Workshops and Service sponsored Transition Seminars/Workshops

b. Use of DD Form 2586 (Verification of Military Experience and Training)

(1) Do you want a copy of your Verification of Military Experience and Training (VMET) Document? If yes, go to to print your VMET document and cover letter.

SERVICE MEMBER

SPOUSE

YES NO N/A YES NO N/A

REFERRED TO

c. DoD Job Search Web site

d. Transition Bulletin Board (TBB) and Public and Community Service Opportunities

e. Teacher and Teacher's Aide Opportunities/Troops to Teachers

f. Federal Employment Opportunities

(1)

(2)

g. Hiring Preference in Non-Appropriated Fund (NAF) jobs (Eligible Involuntary Separatees)

h. State Employment Agencies/America's Job Bank

(1)

i. Reemployment Rights

j. Employer Support for Guard and Reserve (ESGR)

k. Career One Stop

DD FORM 2648-1, JUN 2005

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PRESEPARATION COUNSELING CHECKLIST NAME (Last, First, Middle Initial)

SSN

FOR RESERVE COMPONENT SERVICE MEMBERS

SECTION IV (Continued)

SERVICE MEMBER

SPOUSE

YES NO N/A YES NO N/A

REFERRED TO

12. EDUCATION/TRAINING

a. Education benefits (Montgomery GI Bill, Veterans Educational Assistance Program, Vietnam-era, etc.) Chapter 1606, Title 10, U.S. Code

(1)

b. Workforce Investment Act (WIA)

c. Additional education or training options

(1) Small Business Administration

d. Licensing, Certification and Apprenticeship Information

(1) Department of Labor

(2) U.S. Army

(3) U.S. Military Apprenticeship Program

(4) DANTES

e. Defense Activity for Non-Traditional Educational Support

f. Loan Relief for Military Personnel Called to Active Duty (See Section 8 of the Guide, "Demobilization and Transition Benefits", read section on Students.)

13. HEALTH AND LIFE INSURANCE

a. Transitional Health Care Benefit - for Eligibility Criteria and additional information go to:

(1) A member of a reserve component who is separated from active duty to which called or ordered in support of a contingency operation if the active duty is for a period of more than 30 days.

(2) A member who is separated from active duty for which the member is involuntarily retained (Stop Loss) in support of a contingency operation.

(3) A member who is separated from active duty served pursuant to a voluntary agreement of the member to remain on active duty for a period of less than one year in support of a contingency operation.

b. Option to purchase 18-month conversion health insurance. Concurrent pre-existing condition coverage with purchase of conversion health insurance.

c. Veterans' Group Life Insurance (VGLI)

d. Veterans' Centers

14. FINANCES

a. Unemployment compensation

b. Other financial assistance (VA Loans, SBA Loans, and other government grants and loans)

c. Post Deployment Pay - Defense Finance and Accounting Service (DFAS)

15. VA BENEFITS BRIEFINGS

16. DISABLED VETERANS BENEFITS

a. Disabled Transition Assistance Program (DTAP)

b. VA Disability Benefits

17. SOLDIERS AND SAILORS RELIEF ACT

18. INDIVIDUAL TRANSITION PLAN (ITP)

a. As a separating Service member, after receiving basic preseparation counseling information and completing this checklist, you and your spouse (if applicable) are entitled to receive assistance in developing an Individual Transition Plan (ITP) based on the areas of interest you have identified on this checklist. The preseparation counseling checklist addresses a variety of transition services and benefits to which you may be entitled. Each individual is strongly encouraged to take advantage of the opportunity to develop an ITP. The purpose of the ITP is to identify educational, training, and employment objectives and to develop a plan to help you achieve these objectives. It is the Military Department's responsibility to offer Service members the opportunity and assistance to develop an ITP. It is the Service member's responsibility to develop an ITP based on his/her specific objectives and the objectives of his or her spouse, if appropriate.

b. Based upon information received during Preseparation Counseling, do you desire assistance in developing your ITP? If yes, the Transition staff/Command Career Counselor is available to assist you.

DD FORM 2648-1, JUN 2005

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PRESEPARATION COUNSELING CHECKLIST NAME (Last, First, Middle Initial)

FOR RESERVE COMPONENT SERVICE MEMBERS SECTION V - REMARKS (Attach additional pages if necessary)

SSN

DD FORM 2648-1, JUN 2005

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